Larissa Loures Mendes

Validade e reprodutibilidade de marcadores do consumo de alimentos e bebidas de um inquérito telefônico realizado na cidade de Belo Horizonte (MG), Brasil

OBJECTIVE To evaluate the validity and reproducibility markers of food and beverage intake obtained by means of a telephone-based surveillance system. METHODS Reproducibility was assessed by means of repeated interviews with a 7-15 day interval after the first interview of the system (n=258). Validity was analyzed based on three interviews corresponding to the 24 hour recall method, used as gold standard, 3 days a week, 7 to 15 days after the original telephone interview (n=217). In the study of reproducibility, kappa statistics was used to measure the similarity between the results of the proportions obtained in the first and second interviews. For validation, the proportion of positive reports regarding foods and beverages at the original telephone interview was compared to that obtained by the 24 hour recall method, and the results was analyzed by calculating sensitivity, specificity and positive predictive value. RESULTS In the reproducibility study, the agreement was almost perfect for the marker milk consumption (0.86), substantial for fruit consumption (0.67), intake of fruits and vegetables, intake of meat with fat and alcohol abuse. The agreement was moderate for the intake of soft drink, and fair for the consumption of vegetables. Regarding the validity, there was an underestimation of fruit, vegetable and milk consumption, except for meat and alcohol when compared with the consumption frequency estimated from the three 24-hours recalls, differences related to soft drink consumption was inexpressive. CONCLUSION The instruments enabled the surveillance of factors which were potentially associated with chronic diseases, however, it is a priority to continue with validation studies in other populations to provide greater system reliability, always considering possible limiting factors.OBJETIVO: avaliar a reprodutibilidade e validade de indicadores de consumo de alimentos e bebidas levantados por meio de entrevistas telefonicas pelo Sistema de Vigilância de Fatores de Risco e Protecao para Doencas Cronicas por Telefone (VIGITEL). METODOS: A reprodutibilidade foi aferida por meio de entrevistas repetidas com intervalos de 7 a 15 dias a partir da primeira entrevista original do sistema (n=258). A validade foi avaliada usando como padrao ouro 3 entrevistas correspondentes a recordatorios de 24h (R24h) em 3 dias da semana, apos 7 a 15 dias da entrevista telefonica original (n=217). No estudo de reprodutibilidade a estatistica kappa foi utilizada para medir a concordância entre os resultados das proporcoes obtidas na primeira e na segunda entrevista. Para a validacao, a proporcao de referencia positiva de alimentos e bebidas na entrevista telefonica original foi comparada aquela obtida nos R24h e sua avaliacao foi analisada por meio do calculo da sensibilidade, especificidade e valor preditivo positivo. RESULTADOS: No estudo de reprodutibilidade, observou-se concordância quase perfeita para o indicador de consumo de leite com teor integral de gordura (0,86); concordância substancial para consumo de frutas (0,67), consumo de frutas e hortalicas, consumo de carne com gordura ou frango com pele e consumo abusivo de bebida alcoolica; concordância moderada para o indicador de consumo de refrigerante; e concordância regular para o indicador do consumo de hortalicas. Com relacao ao estudo de validacao, observou-se subestimacao de indicadores de consumo de frutas, hortalicas e leite integral, exceto para consumo de carne/frango com gordura e bebida alcoolica, quando comparados com a frequencia desse consumo estimada a partir dos tres R24horas; as diferencas para o consumo de refrigerantes foi inexpressiva. CONCLUSAO: Verificou-se que os instrumentos utilizados permitem a vigilância de fatores potencialmente associados a doencas nao transmissiveis, entretanto, e prioritaria a continuidade de estudos de validacao em outras populacoes do sistema, com o objetivo de oferecer maior confiabilidade aos mesmos, sempre considerando as potenciais limitacoes.

Built environment and social environment: associations with overweight and obesity in a sample of Brazilian adults

Caracteristicas do ambiente no qual as pessoas vivem, como nivel socioeconomico da vizinhanca, disponibilidade e acesso para a aquisicao de generos alimenticios saudaveis, oportunidades para a pratica de atividade fisica e deslocamento a pe ou de bicicleta, tem sidopropostas como fatores associados a epidemia de obesidade em diversos paises. Este estudo tem por objetivo estimar associacoes das variaveis ambientais e individuais com o excesso de peso na populacao adulta da cidade de Belo Horizonte, Minas Gerais. O estudo foidesenvolvido utilizando dados do Sistema de Vigilância de Fatores de Risco e de Protecao para Doencas Cronicas Nao Transmissiveis por meio de Inquerito Telefonico (VIGITEL) com informacoes da amostra de Belo Horizonte para os anos de 2008 e 2009. Para compor os dados individuais entrevistas telefonicas com informacoes sociodemograficas, alimentacao, peso, altura, atividade fisica e informacoes do estado de saude foram utilizadas. Para caracterizar o ambiente construido, utilizaram-se informacoes georreferenciadas com enderecos e codigos de enderecamento postais (CEPs) dos supermercados, superlojas,hipermercados e estabelecimentos especializados na venda de frutas, legumes e verduras, com o intuito de avaliar a disponibilidade dos alimentos. Alem disso, informacoes georreferenciadas dos parques, pracas publicas, locais para a pratica de atividade fisica e densidade populacional foram utilizados para compor as variaveis do ambiente construido. O indice de vulnerabilidade a saude (IVS), a taxa de homicidio e a renda do setor censitario foram utilizadas para caracterizar o ambiente social. O nivel de agregacao utilizado para analisar os dados foi o setor censitario. A regressao de Poisson multinivel nao foi utilizadapara caracterizar o modelo final, pois os dados nao apresentavam estrutura hierarquizada. Foram propostos cinco modelos ajustados. Verificou-se que o 2° e 4° quartis de densidade populacional apresentaram uma relacao inversa com o excesso de peso. Individuos que residiam em setores censitarios com o IVS muito elevado apresentaram maiores prevalencias de excesso de peso e essa relacao se mantem consistente em todos os modelos. Em relacao aoambiente social a taxa de homicidio foi diretamente associada ao excesso de peso. Nos demais modelos, foram adicionadas variaveis individuais relacionadas ao estilo de vida e aos comportamentos de saude. Verificou-se que o habito de assistir televisao todos os dias dasemana, o nao deslocamento para o trabalho a pe ou de bicicleta e o pior autorrelato do estado de saude se associaram diretamente ao excesso de peso. Variaveis relacionadas ao consumo alimentar como o habito de consumir leite integral e o habito de consumir frango com peleforam tambem diretamente associadas ao excesso de peso. As evidencias encontradas neste estudo mostram que caracteristicas dos locais em que as pessoas vivem estao associadas ao excesso de peso.The aim of this study was to assess associations between the built environment and social environment and excess weight in an urban population. Participants were selected from the Surveillance System for Risk Factors for Chronic Diseases (VIGITEL). The study used data from the city of Belo Horizonte, Minas Gerais State, Brazil. A total of 3,425 interviews from the years 2008 and 2009 were used. Georeferenced data on parks, squares, and locations for physical exercise, population density, and food stores were used to assess the built environment. Description of the social environment used income and homicide rate for the neighborhood. Environmental variables associated independently with excess weight were population density, presence of parks, squares, and locations for physical exercise, and self-reported presence of locations for physical exercise. The findings show that residential neighborhood characteristics are associated with excess weight in urban adults.

Individual and environmental factors associated for overweight in urban population of Brazil

BackgroundObesity is a significant global public health problem and the main cause of many chronic diseases in both developed and developing countries. The increase in obesity in different populations worldwide cannot be explained solely by metabolic and genetic factors; environmental and social factors also have a strong association with obesity. Thus, it is believed that the current obesity epidemic is the result of a complex combination of genetic factors and an obesogenic environment .The purpose of this study was to evaluate individual variables and variables within the built and social environment for their potential association with overweight and obesity in an urban Brazilian population.MethodsCross-sectional study was carried out in a sample of 3404 adults living in the urban area of the city. Information from the surveillance system for chronic diseases of Brazilian Ministry of Health was used and individual data was collected by telephone interviews. The database was geocoded using the Brazilian System of Postal Codes for participant residences. An updated, existing list based on the current addresses of supermarkets and hypermarkets in the city was used as an indicator variable of the availability and access to food. Georeferenced information on parks, public squares, places for practicing physical activity and the population density were also used to create data on the built environment. To characterize the social environment, we used the health vulnerability index (HVI) and georeferenced data for homicide locations.ResultsThe prevalence was 44% for overweight, poisson regression was used to create the final model. The environment variables that independently associated with overweight were the highest population density, very high health vulnerability index and the homicide rate adjusted for individuals variables. The results of the current study illustrate and confirm some important associations between individual and environmental variables and overweight in a representative sample of adults in the Brazilian urban context.ConclusionsThe social environment variables relating to the socioeconomic deprivation of the neighborhood and the built environment variables relating to higher walkability were significantly associated with overweight and obesity in Belo Horizonte.

Fatores associados à resistência à insulina em populações rurais

This study explores the relations of anthropometric, body composition assessments, biochemical and hemodynamic parameters with insulin resistance in two rural communities. Sample was composed by adults aged 18 or older, both sexes. Participants were excluded if pregnant and diabetic. Data collection included demographic lifestyle, hemodynamic, anthropometric and biochemical variables. From the 567 subjects, 50.4% were men and 49.6%, women. Most of the sample was non-white (75.7%), lived with partner (69.3%) and had low educational level. Overweight and obesity prevalences were 17.4% and 5.5%, respectively. Multivariate analysis found risk factors associated to insulin resistance for non-diabetic adults with low income and educational level: overweight, obesity, elevated waist-to-hip ratio, C-reactive protein and skin color.

Diferenças na atenção pré-natal nas áreas urbanas e rurais do Brasil: estudo transversal de base populacional

This study aimed at comparing antenatal care provided in Brazilian urban and rural contexts. A cross-sectional population-based survey was conducted grounded in the 2006 Children and Women’s Health and Demography National Survey (in Portuguese, PNDS) data with a sample of 588 women. Stata version 9.0 was used for data analysis, using chi-square test and significance level at 5% (p <0.05). Chi-square test was applied to verify prevalence differences between pregnant woman living in Brazilian rural and urban areas regarding socioeconomic and demographic situation and the antenatal care protocols of the Antenatal and Birth Humanization Program (in Portuguese, PHPN). Results revealed significant differences depending on the level of education (p=0.0071), gross household income (p=0.0001), private health insurance coverage (p=0.0023), syphilis testing (p=0.0293), hepatitis testing (p=0.0424), being offered toxoplasmosis (p=0.0452) and HIV (p=0.0132) tests. Best results were obtained among pregnant women living in urban areas. The rates of prevention of nutritional deficiencies, tetanus vaccination and number of antenatal visits were unsatisfactory in both areas. This study pointed out that the quality of antenatal care provided is deficient and that the antenatal care delivered in rural areas is even less adequate.

Tendências da frequência do consumo de feijão por meio de inquérito telefônico nas capitais brasileiras, 2006 a 2009

The scope of this paper was to analyze the trends of frequency of consumption of beans between the years 2006 and 2009 in the Brazilian capitals. This is a historical series using the Vigitel database for all Brazilian state capitals. Consumption of beans was described in terms of relative frequency and the trend was assessed using Poisson regression. Between 65.79% (2009) and 71.85% (2006) of participants reported consuming beans five or more days per week. The capitals Goiania, Belo Horizonte, Palmas, Brasilia and Cuiaba were in the highest frequency range of consumption throughout the study period. Individuals with a BMI in the appropriate and low weight category had the highest frequencies of consumption in comparison with the overweight and the obese. A significant reduction trend in the consumption of beans per year of the research, except for the 45 to 54-year-old range, was detected. The conclusion drawn was that there has been a significant reduction in the consumption of beans in the Brazilian population and the adoption of monitoring and incentive policies is necessary due to the benefits of the legume.

Physical and Social Environment Are Associated to Leisure Time Physical Activity in Adults of a Brazilian City: A Cross-Sectional Study

The physical activity practice is highlighted as a strategy to health promotion and to avoid chronic diseases. In addition to individual factors, environmental characteristics in which people live, may offer opportunities or barriers in adopting healthy habits and this is related to the physical activity (PA) practice among individuals. The aim of this study is to investigate the associations between neighborhood environment and leisure-time physical activity in adults. This is a cross-sectional study, developed using the database of Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL 2008/2010) of Belo Horizonte, Brazil. Individuals with the habit of practicing PA for at least 150 minutes of moderate-intensity PA or at least 75 minutes of vigorous-intensity PA throughout the week in leisure time were classified as active in leisure time. To characterize the built and social environment we used georeferenced data of public and private places for physical activity, population density, residential density, homicide rate and total income of the coverage area of the basic health units. The covered area of the basic health units was used as context unit. For data analysis, we used multilevel logistic regression. The study included 5779 adults, 58.77% female. There was variability of physical activity in leisure time between area covered by the basic health units (Median Odds ratio = 1.30). After adjusting for individual characteristics, the increase of density of private places for physical activity (Odds ratios—OR = 1.31; 95% confidence interval—95% CI: 1.15 to 1.48) and the smaller homicide rate (OR = 0.82; IC95%: 0.70 to 0.96) in the neighborhood increased physical activity in leisure time. The evidence of this study shows that neighborhood environment may influence the physical activity practice in leisure time and should be considered in future interventions and health promotion strategies.

Availability of food stores and consumption of fruit, legumes and vegetables in a Brazilian urban area

BACKGROUND The food environment can have an important influence on the availability of and access to food, which plays a significant role in the health of individuals. The goal of this study was to compare the consumption of fruits, legumes and vegetables (FLV) by adults and the availability of food stores in the context of socioeconomic and geographic space connected to basic health units in a Brazilian capital city. METHODS The study was developed from information obtained through the Risk Factors Surveillance for Non-Communicable Diseases Prevention by Telephone Survey (VIGITEL), using samples from Belo Horizonte from the years 2008 to 2010. A total of 5611 records were geocoded based on the postal code. A score was created based on the weekly and daily frequency of FLV intake of individuals. The coverage area of basic health units was used as a neighborhood unit. Georeferenced data on food stores in the city and neighborhood income were used. RESULTS As neighborhood income increased, there was an increase in the distribution of food establishments for all of the studied categories. The highest FLV intake scores were observed in areas with higher income levels. CONCLUSION The highest concentration of food stores, regardless of supply quality, was observed in geographic areas with higher purchasing power and in those where there was a greater concentration of other types of businesses and services, a different pattern from that found in other countries.

Daily meal frequency and associated variables in children and adolescents

OBJECTIVE To investigate the frequency distribution of daily meals and its relation to demographic, socioeconomic, behavioral, anthropometric and biochemical factors in children and adolescents. METHODS This was a cross-sectional study with a representative sample of 708 schoolchildren aged 7-14 years. Data on personal information, socioeconomic status, physical activity and number of meals were obtained through semi-structured questionnaire and consumption by 24-h recall and food record. Weight and height measurements were also performed to calculate the body mass index. Finally, blood samples were collected for analysis of total cholesterol, high- and low density lipoprotein, triglyceride, and glucose levels. Descriptive statistics, the Mann-Whitney test, and Poisson regression were used in statistical analysis. RESULTS Meal frequency <4 was associated in children, family income <3 Brazilian minimum wages (PR=5.42; 95% CI: 1.29-22.77; p=0.021) and adolescents, the number of sons in the family >2 (PR=1.53; 95% CI: 1.11-2.11; p=0.010). Even in the age group of 10-14 years, <4 meals was related to higher prevalence of body mass index (PR=1.33; 95% CI: 1.02-1.74; p=0.032) and low-density lipoprotein (PR=1.39; 95% CI: 1.03-1.87; p=0.030) higher after adjustments. CONCLUSION Lower frequency of meals was related to lower income in children and adolescents, larger number of sons in the family, and increased values of body mass index and low-density lipoprotein.

Association between fat mass index and fat-free mass index values and cardiovascular risk in adolescents

Abstract Objective: To describe the association between fat mass index and fat-free mass index values and factors associated with cardiovascular risk in adolescents in the city of Juiz de Fora, Minas Gerais. Methods: Cross-sectional study was with 403 adolescents aged 10–14 years, from public and private schools. Anthropometric, clinical, and biochemical measurements were obtained, as well as self-reported time spent performing physical exercises, sedentary activities and sexual maturation stage. Results: Regarding the nutritional status, 66.5% of the adolescents had normal weight, 19.9% were overweight and 10.2% were obese. For both genders, the fat mass index was higher in adolescents who had high serum triglycerides, body mass index and waist circumference. Conclusions: Adolescents who had anthropometric, clinical and biochemical characteristics considered to be at risk for the development of cardiovascular disease had higher values of fat mass index. Different methodologies for the assessment of body composition make health promotion and disease prevention more effective.